/ AQDM-05
AQDM protocol review form
Air Quality Dispersion Modeling (AQDM)
(Previously AQDMPRF-01)
Doc Type: Air Dispersion Modeling

Instructions: This form is used for Minnesota Pollution Control Agency (MPCA) internal use by Air Dispersion Modelers, Air Permit Engineers, and Risk Assessors to review modeling protocols.

Note: If protocol is marked not approved, please use the AQDM-1.5 form to resubmit. AQDM-1.5 forms and updated attachments should be emailed to: . If files are too large to email, please mail a CD with the files to:

Air Quality Permit Document Coordinator

Minnesota Pollution Control Agency

520 Lafayette Road North

St. Paul, MN 55155-4194

Protocol information

Facility name: / Today’s date (mm/dd/yyyy):
AQ facility/permit ID number: / Three-letter modeling facility ID (ex., ACE, XAK, MEC, NUP, etc.):
Tempo AI ID number: / Date protocol was received at the MPCA (mm/dd/yyyy):
MPCA Air Dispersion Modeler: / MPCA Air Permit Engineer:
MPCA Air Risk Assessor:

Modeling protocol review by sections – Completed by Air Dispersion Modeler

Section name / Acceptable/ Unacceptable / Deficiencies and/or comments
Modeling purpose / [select from list]AcceptableUnacceptable
Terrain / [select from list]AcceptableUnacceptable
Buildings / [select from list]AcceptableUnacceptable
Model selection and options / [select from list]AcceptableUnacceptable
Point sources / [select from list]AcceptableUnacceptable
Volume sources / [select from list]AcceptableUnacceptable
Area sources / [select from list]AcceptableUnacceptable
Area source coordinates / [select from list]AcceptableUnacceptable
Paved roads fugitive dust / [select from list]AcceptableUnacceptable
Receptors / [select from list]AcceptableUnacceptable
Meteorological data / [select from list]AcceptableUnacceptable
Area of impact analysis / [select from list]AcceptableUnacceptable
Background values / [select from list]AcceptableUnacceptable
Nearby sources / [select from list]AcceptableUnacceptable
Pollutant based considerations / [select from list]AcceptableUnacceptable
Attachments / [select from list]AcceptableUnacceptable
Aqdm-02 Form / [select from list]AcceptableUnacceptable
This section is: / [select from list]AcceptableConditionally AcceptableUnacceptable
Comments on status:

Modeling protocol review by sections – Completed by Air Permit Engineer

Section name / Acceptable/ Unacceptable / Deficiencies and/or comments
Modeling purpose / [select from list]AcceptableUnacceptable
Modeling selection and options / [select from list]AcceptableUnacceptable
Point sources / [select from list]AcceptableUnacceptable
Volume sources / [select from list]AcceptableUnacceptable
Area sources / [select from list]AcceptableUnacceptable
Paved roads fugitive dust / [select from list]AcceptableUnacceptable
Nearby sources / [select from list]AcceptableUnacceptable
Pollutant based considerations / [select from list]AcceptableUnacceptable
Attachment: Aqdm-02 Form / [select from list]AcceptableUnacceptable
Attachment: Nearby Source Emission Calculations (If Applicable) / [select from list]N/AAcceptableUnacceptable
Comments on other sections:
This section is: / [select from list]AcceptableConditionally AcceptableUnacceptable
Comments on status:

Modeling protocol review by sections – Completed by Air Risk Assessor (If Applicable)

AERA form name / Acceptable/ Unacceptable/ Not applicable / Deficiencies and/or comments
All projects:
Deliverable checklist | AERA-01 / [select from list]AcceptableUnacceptableNot applicable
Dispersion factor analysis | AERA-03 / [select from list]AcceptableUnacceptableNot applicable
Emissions calculations | AERA-05 / [select from list]AcceptableUnacceptableNot applicable
Qualitative information | AERA-02 / [select from list]AcceptableUnacceptableNot applicable
Cumulative air emissions risk analysis | AERA-19 / [select from list]AcceptableUnacceptableNot applicable
AERA certification | AERA-24 / [select from list]AcceptableUnacceptableNot applicable
RASS and Q/CHI risk screening spreadsheets / [select from list]AcceptableUnacceptableNot applicable
If applicable:
Emergency internal combustion engine certification | AERA-04 / [select from list]AcceptableUnacceptableNot applicable
Process flow diagram | GI-02 / [select from list]AcceptableUnacceptableNot applicable
Facility and stack/vent diagram | GI-03 / [select from list]AcceptableUnacceptableNot applicable
Determination checklist for proposed ethanol facilities | AERA-13 / [select from list]AcceptableUnacceptableNot applicable
Refined HHRAP-based analysis form | AERA-26 / [select from list]AcceptableUnacceptableNot applicable
MPCA Mercury risk estimation method (MMREM) protocol form | AERA-27 / [select from list]AcceptableUnacceptableNot applicable
Assessing impacts of mercury release to ambient air | Hg-2003 / [select from list]AcceptableUnacceptableNot applicable
Mercury risk assessment spreadsheet | aq9-17 / [select from list]AcceptableUnacceptableNot applicable
Attachments: / [select from list]AcceptableUnacceptableNot applicable
Comments on other materials:
This section is: / [select from list]AcceptableConditionally AcceptableUnacceptableNot applicable
Comments on status:

Overall status of modeling protocol

This modeling protocol is: / [select from list]ApprovedConditionally Approved; See CommentsNot Approved; See comments and revise accordingly
Comments on approvable-status:

www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats

aq2-44 • 10/20/17 Page 1 of 3